Atrial electrical remodeling induced by chronic ischemia and inflammation in patients with stable coronary artery disease

Șerban, Răzvan Constantin; Balan, Alkora Ioana; Perian, Marcel; Pintilie, I; Somkereki, Cristina; Huţanu, Adina; Scridon, Alina

doi:10.4103/cjp.cjp_2_19

Cited by 12 publications

(5 citation statements)

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“…In the present study, systolic blood pressure < 110 mmHg and LVEF < 43% on admission, age > 51 years, and presence of CKD independently predicted the occurrence of STEMI-related arrhythmic complications. Meanwhile, in line with the recent data reported by Crenshaw et al [ 26 ], other classic cardiovascular risk factors known to promote proarrhythmic atrial electrical and/or structural remodeling, such as hypertension, heart failure, diabetes mellitus, or chronic respiratory disease [ 27 , 28 , 29 ], many of which are included in the CHA 2 DS 2 -VASc score, had no significant impact on the occurrence of post-STEMI arrhythmias. Consequently, the CHA 2 DS 2 -VASc score had no predictive value for post-STEMI arrhythmias.…”

Section: Discussionsupporting

confidence: 72%

“…It is now widely accepted that the pathophysiology of AF relies on a combination of ectopic triggers that initiate the arrhythmia and an arrhythmogenic substrate that ensures the formation of reentry circuits and, hence, the persistence of the arrhythmia [ 27 ]. In STEMI, factors such as acute ischemia, myocardial inflammation, sympathetic overactivation, metabolic and electrolyte imbalance, and hemodynamic impairment have been related to a significant increase in atrial ectopic activity, whereas the burden of chronic cardiovascular risk factors, such as those included in the CHA 2 DS 2 -VASc score, are known to promote atrial proarrhythmic electrical and structural remodeling [ 27 , 28 , 30 ]. The combination of chronic and acute risk factors and its ability to provide the optimal environment for AF to occur could, thus, explain the ability of both the CHA 2 DS 2 -VASc and GRACE scores to independently predict STEMI-related new-onset AF.…”

Section: Discussionmentioning

confidence: 99%

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The CHA2DS2-VASc Score Predicts New-Onset Atrial Fibrillation and Hemodynamic Complications in Patients with ST-Segment Elevation Myocardial Infarction Treated by Primary Percutaneous Coronary Intervention

Cozac

Lakatos

Demjen³

et al. 2022

Diagnostics

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Arrhythmic and hemodynamic complications related to ST-segment elevation myocardial infarction (STEMI) represent a major clinical challenge. Several scores have been developed to predict mortality in STEMI. However, those scores almost exclusively include factors related to the acute phase of STEMI, and no score has been evaluated to date for its ability to specifically predict arrhythmic and hemodynamic complications. We, thus, aimed to assess the ability of chronic risk factors burden, as expressed by the CHA2DS2-VASc score, to predict STEMI-related arrhythmic and hemodynamic complications. Data were collected from 839 consecutive STEMI patients treated by primary percutaneous coronary interventions (pPCI). CHA2DS2-VASc and GRACE scores were calculated for all patients, and their ability to predict STEMI-related arrhythmic (i.e., new-onset atrial fibrillation (AF), ventricular tachycardia/fibrillation) and hemodynamic (i.e., cardiogenic shock, asystole) complications was assessed in univariate and multiple regression analysis. Arrhythmic and hemodynamic complications occurred in 14.8% and 10.2% of patients, respectively. Although the GRACE score outweighed the CHA2DS2-VASc score in the ability to predict STEMI-related hemodynamic complications (p < 0.0001), both scores had a similar predictive value for STEMI-related new-onset AF (p = 0.20), and both remained independent predictors of new-onset AF and of hemodynamic complications in the multiple regression analyses. A CHA2DS2-VASc score > 2 points independently predicted new-onset AF (p < 0.01) and hemodynamic complications (p = 0.04). Alongside the GRACE score, the CHA2DS2-VASc score independently predicted new-onset AF and hemodynamic complications in STEMI patients treated by pPCI. These data suggest that a combination of acute and chronic risk factors could provide additional benefit in identifying patients at risk of STEMI-related complications, who could benefit from closer follow-up and more intensive prophylactic and therapeutic strategies.

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Section: Discussionsupporting

confidence: 72%

Section: Discussionmentioning

confidence: 99%

The CHA2DS2-VASc Score Predicts New-Onset Atrial Fibrillation and Hemodynamic Complications in Patients with ST-Segment Elevation Myocardial Infarction Treated by Primary Percutaneous Coronary Intervention

Cozac

Lakatos

Demjen³

et al. 2022

Diagnostics

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“…Myocardial inflammation is a critical process occurring in the setting of AMI that has been related to a variety of deleterious consequences, including electrical instability and increased risk of cardiac arrhythmias, autonomic dysfunction, and fibrosis development [ 48 , 62 , 63 , 64 ]. A wide variety of pro-inflammatory cytokines have been shown to increase in the setting of AMI and to predict prognosis in this population.…”

Section: Newer Biomarkers For Laboratory Diagnosis Of Acute Myocardial Infarctionmentioning

confidence: 99%

Past, Present, and Future of Blood Biomarkers for the Diagnosis of Acute Myocardial Infarction—Promises and Challenges

Ţilea

Varga

Șerban³

2021

Diagnostics

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Despite important advancements in acute myocardial infarction (AMI) management, it continues to represent a leading cause of mortality worldwide. Fast and reliable AMI diagnosis can significantly reduce mortality in this high-risk population. Diagnosis of AMI has relied on biomarker evaluation for more than 50 years. The upturn of high-sensitivity cardiac troponin testing provided extremely sensitive means to detect cardiac myocyte necrosis, but this increased sensitivity came at the cost of a decrease in diagnostic specificity. In addition, although cardiac troponins increase relatively early after the onset of AMI, they still leave a time gap between the onset of myocardial ischemia and our ability to detect it, thus precluding very early management of AMI. Newer biomarkers detected in processes such as inflammation, neurohormonal activation, or myocardial stress occur much earlier than myocyte necrosis and the diagnostic rise of cardiac troponins, allowing us to expand biomarker research in these areas. Increased understanding of the complex AMI pathophysiology has spurred the search of new biomarkers that could overcome these shortcomings, whereas multi-omic and multi-biomarker approaches promise to be game changers in AMI biomarker assessment. In this review, we discuss the evolution, current application, and emerging blood biomarkers for the diagnosis of AMI; we address their advantages and promises to improve patient care, as well as their challenges, limitations, and technical and diagnostic pitfalls. Questions that remain to be answered and hotspots for future research are also emphasized.

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“…Increased oxidative stress observed in obese patients activates a series of processes (including atrial inflammation, fibrosis, and electrical remodeling) that are, in turn, involved in the occurrence of AF [153,154]. But, these processes, including oxidative stress, are also a consequence of AF.…”

Section: Discussionmentioning

confidence: 99%

Oxidative Stress, Inflammation, and Mitochondrial Dysfunction: A Link between Obesity and Atrial Fibrillation

Balan,

Halațiu,

Scridon

2024

Antioxidants

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The adipose tissue has long been thought to represent a passive source of triglycerides and fatty acids. However, extensive data have demonstrated that the adipose tissue is also a major endocrine organ that directly or indirectly affects the physiological functions of almost all cell types. Obesity is recognized as a risk factor for multiple systemic conditions, including metabolic syndrome, type 2 diabetes mellitus, sleep apnea, cardiovascular disorders, and many others. Obesity-related changes in the adipose tissue induce functional and structural changes in cardiac myocytes, promoting a wide range of cardiovascular disorders, including atrial fibrillation (AF). Due to the wealth of epidemiologic data linking AF to obesity, the mechanisms underlying AF occurrence in obese patients are an area of rich ongoing investigation. However, progress has been somewhat slowed by the complex phenotypes of both obesity and AF. The triad inflammation, oxidative stress, and mitochondrial dysfunction are critical for AF pathogenesis in the setting of obesity via multiple structural and functional proarrhythmic changes at the level of the atria. The aim of this paper is to provide a comprehensive view of the close relationship between obesity-induced oxidative stress, inflammation, and mitochondrial dysfunction and the pathogenesis of AF. The clinical implications of these mechanistic insights are also discussed.

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Atrial electrical remodeling induced by chronic ischemia and inflammation in patients with stable coronary artery disease

Cited by 12 publications

References 0 publications

The CHA2DS2-VASc Score Predicts New-Onset Atrial Fibrillation and Hemodynamic Complications in Patients with ST-Segment Elevation Myocardial Infarction Treated by Primary Percutaneous Coronary Intervention

The CHA2DS2-VASc Score Predicts New-Onset Atrial Fibrillation and Hemodynamic Complications in Patients with ST-Segment Elevation Myocardial Infarction Treated by Primary Percutaneous Coronary Intervention

Past, Present, and Future of Blood Biomarkers for the Diagnosis of Acute Myocardial Infarction—Promises and Challenges

Oxidative Stress, Inflammation, and Mitochondrial Dysfunction: A Link between Obesity and Atrial Fibrillation

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